title: Analysis of medical emergency team calls comparing subjective to "objective" call criteria.
abstract: OBJECTIVE
  To explore the reasons why nursing staff use the subjective "worried" Medical Emergency Team (MET) calling criterion and compare the outcomes of calls activated using the "worried" criterion with those calls activated using "objective" criteria such as vital sign abnormalities.
  
  
  METHODS
  A descriptive study of MET calls in six acute hospitals over a 12 months period. Outcomes for "objective" and "worried" calls were compared.
  
  
  RESULTS
  The "worried" criterion was used to activate 29% of 3194 MET calls studied; it was the single most common reason for a MET call. Half (51.7%) of the "worried" calls were related to problems with Airway, Breathing, Circulation or Neurology. 'Breathing' problems accounted for the largest proportion (35.2%). A low oxygen saturation by pulse oximetry (SpO2) (n=249, 26.9%) and 'respiratory distress' (n=133, 14.4%) were the most common reasons for a "worried" call. Only 1.1% (10) of calls triggered by the "worried" criteria had cardiac arrest as an outcome compared with 170 calls (7.6%) for "objective" criteria. The proportion of patients who remained in a general ward area after MET calls was higher for the "worried" calls.
  
  
  CONCLUSIONS
  The "worried" criterion was the most frequent reason for MET calls, implying a high degree of empowerment and independent action by nursing staff. Low SpO2 and respiratory distress were the most common causes for concern. There was a significant difference between MET calls triggered by "worried" criteria and "objective" criteria for outcomes immediately following MET (p < 0.001). Further assessment and refinement of MET triggers particularly in relation to respiratory distress and pulse oximetry may be needed.
authors.affiliation: The Simpson Centre for Health Services Research, Liverpool Health Service, Locked Bag 7103, Liverpool BC, NSW 1871, Australia. nancy.santiano@swsahs.nsw.gov.au
authors.forename: Nancy
authors.initials: N
authors.lastname: Santiano
authors.forename: Lis
authors.initials: L
authors.lastname: Young
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman
authors.forename: Michael
authors.initials: M
authors.lastname: Parr
authors.forename: Sanjay
authors.initials: S
authors.lastname: Jayasinghe
authors.forename: La-Stacey
authors.initials: LS
authors.lastname: Baramy
authors.forename: Jayne
authors.initials: J
authors.lastname: Stevenson
authors.forename: Tracey
authors.initials: T
authors.lastname: Heath
authors.forename: Cassandra
authors.initials: C
authors.lastname: Chan
authors.forename: Maree
authors.initials: M
authors.lastname: Claire
authors.forename: Gail
authors.initials: G
authors.lastname: Hanger
mesh_terms: D001315:Australia; D004630:Emergencies / Q000145:classification* / Q000451:nursing; D004632:Emergency Medical Services / Q000145:classification* / Q000706:statistics & numerical data*; D006801:Humans; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care